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7
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lO. 1

. 1
lERSTS

. 231.— Vol. XX, No. 1.

[JANUARY, 1908.

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THE BRITIS^#^'^^*''^'^''>^=,

JOURNAL OF DEPiliTOLOGY

CONTENTS.

Notes of a Case of Congenital Ichthyosis Hystrix Linearis or
Hystricismus (syn. : Ichthyosis Cornea, Njevus Verrucosus,
VEL N.EVUS Papillaris, vel Papilloma Neuroticum, etc.)
J. H. STOWERS, M.D

A Further Note on the Etiology of Infantile Eczema.
J. HALL. M.A., M.D.Cantab., F.R.C.P. .

ARTHUR

EoYAL Society of Medicine — Dermatological Section. — Case for
diagnosis. — Vegetating granulomata on the face. — Favus of the scali). — Bazin's
disease (Erythema induratimi). — " Keratosis foUiciilaris associated with baldness."
— Erythema induratum (Bazin). — Infective gi-anixloma of the right cheek of
septic origin .......... 11

Current Literature — To the knowledge of Urticaria pigmentosa. — A case
of lymphangiectasis with lymphorrhoea. — On the relation of the Spirochseta
pallida to congenital syphilis. — A further contribiition on linear eruptions. —
Histological study on the presence of the Spirochseta pallida in tissues. — Multiple
endothelioma of the scalp. — On Lichen alb\is, a previously undescribed affection.
— On the treatment of cancer of the skin by the X-rays. — On Nsevus ansemicus.
— Folliculitis (sycosis) sclerotisans. — On Lupus erythematodes of the red portion
of the lips and buccal mucosa. — On a new nodvdar eriiption.- Lichen nitidus. —
Spirochaetes in condyloma acuminatum. — Ten Cases of Mycosis fungoides, with
remarks on the histology and Rontgen therapy of the disease. — On Lupus
erythematodes in childhood. — The histological changes in Lupus vulgaris under
Finsen-light treatment. — Multiple telangiectases of the skin and mucous mem-
branes of the nose and mouth . . . . . . .18

Reviews — Light and X-ray Treatment of Skin-diseases. — Lehrbuch der Haut-
und Geschlectskrankheiten. — Transactions of the German Dermatological Society :
Ninth Congress. — Archiv fiir Dermatologie und Syphilis . . . .30

, LONDON

136, GOWER STREET, W.C.

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BRITISH
JOURNAL OF DERMATOLOGY

Edited by J. M. H. MACLEOD.

The Editor will be glad to receive for publication in the Journal
original papers on subjects bearing on Dermatology, clinical records
of unusual cases, observations on treatment, and notes on the histology
and pathology of the skin.

All CoiTespondence respecting Contributions and other Editorial Communica-
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BRITISH JOURNAL OF DERMATOLOGY.

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Subscriptions for 1908 (Vol. XX) are now due, and may be paid
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can be supplied, price Is. 6d. each.

H. K. LEWIS, 136, Gower Street, London, W,C.

TRADE f/^b\ ^^S::MV| TRADE
MARK Iv^PiSL^Mil MARK.

PEBECOL

Belersdorf's Chlorate of Potash Tooth=paste,

A cleansing material for the mouth and teeth, prepared according

to the directions of Dr. P. Q. UNNA, of Hamburg.

For many years prescribed regularly by medical men and dentists.

Pebecol is specially recommended in cases of Stomatitis mercurialis,

Foetor ex ore, and absolutely indispensable for any other

diseases of the oral cavity.

Guttapercha Plastermulls

(Pilot brand), according to Dr. P. G. UNNA

Medicated Plasters of most exact division and highest
concentration on an impermeable layer of guttapercha.

ParaplaStS, according to Dr. P. Q. UNNA.

Impervious Rubber Plasters on skin-like underlayer, similar
in use, indication, and composition to Guttapercha Plaster-
mulls.

SalVCmUllS (Pilot brand), according to Dr. P. Q. UNNA.

Ointment in most accurate doses, spread either on one or
both sides of absorbent muslin, for treatment of secretory
eczema.

TriCOplaStS, according to Dr. E. ARNINQ.

Plasters spread on knitted web, an exceptionally pliant
and permeable tissue for subacute or chronic eczema.

Medicated Superfatted Soaps

(Pilot brand), according to Drs. P. Q. UNNA and P. J. EICHHOFF.

Most carefully made with fresh fat and best medicinal
substances, the percentage of which is guaranteed.

THE ONLY GENUINE PREPARATIONS ACCORDING TO DR. P. G. UNNA.

Sample cases, list, and literature on application.

P. BEIERSDORF & CO.,

CHEMICAL WORKS,

HAIYIBURC. LONDON,

London Branch x 7 & S, IDOL LANE, E.G.

Cbe "Jlllcnburps "

The " Allenburys " Medical Soaps are manufactured by a special process which
admits of the addition of the special medicaments without in any way altering the
composition of the soap-base or of the added ingredients. By this method absolutely
accurate admixture and percentage composition is insured. None of these advantages
can be obtained by the ordinary methods of manufacture usually in vogue.

The following list of Soaps is submitted, some of which have already been in
use for a considerable time, and their utility widely recognised.

Resorcin 2i%

Resorcin i{% with Sulphur 5%

SaHcylic Acid 5% with Sulphur 10%

Carbolic 5% and 10%

Ichthyol 2^% with Resorcin ii%

Ichthyol 5% with Sulphur 5%

Ichthyol 5% with Salicylic Acid 2^%

Ichthyol 5% and 10%

Iodoform 5%

Sulphur 5% with Peru Balsam 2|'
Terebene 10%
Thymol 2i%

A full list of Medical Soaps and a sample tablet of any variety
sent on request.

Allen & Hanburys, Ltd., Kard'sl!; London, EX.

^eltanthum

A Water=Soluble, Protective, Skin Application

Successfully used in the treatment of

ECZEMA, PSORIASIS, LUPUS ERYTHEMATOSUS, ETC.

Practically a non-greasy ointment, drying rapidly and
requiring no dressing or covering.

In addition to Plain " Pellanthum," which is suitably coloured to a Skin Tint,

the following combinations are being extensively used :

"Pellanthum " SUPRARENALIN (for patches of Chronic Eczema).

"Pellanthum" Ichthyol 3%. 5°/o. "Pellanthum" Carbonis Deterg., 10%. 15%.

•' Pellanthum " Ichthyol 5%, et Resorcin 1\ %. " Pellanthum " Chrysarobin 3 %•
" Pellanthum " Acid. Salicylic 1 %, 2 %. " Pellanthum " Rusci 5 %•

"Pellanthum " can T)e combined with all the ordinary Skin Medicaments. It is issued in collapsible
tubes at 1/6, 2 6 and 4'-, and may be obtained through all wholesale firms or from the Manufacturers—

HANDFORD & DAWSON, Chemists, HARROGATE.

THE BRITISH

JOUENAL OF DERMATOLOGY.

JANUARY, 1908.

NOTES OF A CASE OF CONGENITAL ICHTHYOSIS HYSTRIX
LINEARIS OR HYSTRICISMUS {8YN. : ICHTHYOSIS
CORNEA, N^VUS VERRUCOSUS, YEL N^VUS PAPIL-
LARIS, VEL PAPILLOMA NEUROTICUM, ETC.).

By J. H. STOWERS, M.D.

BRITISH JOURNAL OF DERMATOLOGY

Annual Subscription (post free),
ONE GUINEA.

SUBSCRIPTIONS FOR 1908 (VOL. XX) ARE NOW DUE,
and may be paid through any Bookseller, or forwarded
direct to the Publisher, —

H. K. LEWIS, 136, Qower Street, London, W.C.

Single Numbers, Two Shillings.

been made in former years by means of the knife, escharotics, etc.
So far as I could learn the disease, which in parts is characterised

VOL. XX. A

Cbe "flllenburps "

medical Soaps^

The following list of Soaps is submitted, some of which have already been in
use for a considerable time, and their utility widely recognised.

Carbolic 5% and 10%

Ichthyol 2i% with Resorcin ik%

Ichthyol 5% with Sulphur 5%

Ichthyol 5% with Salicylic Acid 2|%

Ichthyol 5% and 10%

Iodoform 5%

Resorcin 2h%

Resorcin ii% with Sulphur 5%

Salicylic Acid 5% with Sulphur 10%

Sulphur 5% with Peru Balsam 2^%

Terebene 10%

Thymol 2i%

A full list of Medical Soaps and a sample tablet of any variety
sent on request.

"Pellanthum " can lie combined with all the ordinary Skin Medicaments. It is issued in collapsiWe
tubes at 1/6, 2 6 and 4'-, and may be obtained thi-ouffh all wholesale firms or from the Manufacturers—

HANDFORD & DAWSON, Chemists, HARROGATE.

THE BRITISH

JOUENAL OF DEEMATOLOGY.

JANUARY, 1908.

NOTES OF A CASE OF CONGENITAL ICHTHYOSIS HYSTRIX
LINEARIS OR HYSTRICISMUS {SYN. : ICHTHYOSIS
CORNEA, N^VUS VERRUCOSUS, YEL N^VUS PAPIL-
LARIS, VEL PAPILLOMA NEUROTICUM, ETC.).

By J. H. STOWERS, M.D.

Physician, Skin-Department, the North-West London Hospital; Vice-President
Dennatological Section Royal Society of Medicine.

At tlie Meeting of the Dermatological Society of Great Britain
and Ireland held on February 27th, 1907, I exhibited an unusually
marked case of the above-named disease, of which a brief notice
appeared in this journal (vol. xix. No. 4, p. 126),

As carefully prepared coloured drawings have been made, it is
desirable that a somewhat fuller account of the case should be
published with illustrations.

The patient, a girl, aged 8 years and 4 months, is the younger of
two children born of healthy parents. She Avas in a somewhat
enfeebled condition of health, although well grown and nourished,
and the subject of talipes varus, for which deformity she was taken
to the City Orthopfedic Hospital to be treated by my colleague, Mr.
Jackson Clarke, thi'ough whose recommendation she was referred to
me.

The lesions, which had slowly developed from the date of birth to
the age of six years, had since undergone but little change, and there
was no indication of spread or of new areas becoming involved.

Unsuccessful attempts at removal, however, of some of them had
been made in former years by means of the knife, escharotics, etc.

So far as I could learn the disease, which in parts is characterised

VOL. XX. A

2 CONGENITAL ICHTHYOSIS HYSTRIX LINEAEIS.

l)y marked syminetiy^ developed upon the lower extremities and trunk
before it appeared upon the arms, forearms, and hands.

When first seen by me the eruption existed upon the left shoulder
(one small encrusted patch being upon the right shoulder only), the
left side of the chest (in front near the axilla), the abdomen (left side)

"f.

!»•

(•^•%4ij!

•^

V ;^

and buttocks (chiefly the right, including the pudenda), both arms,
forearms and hands, the left thigh, leg and foot.

The front and back of the chest and right lower extremity were
practically free. The lesions themselves varied considerably in form,
colour, and degree, but the papillary or verrucose character was
very marked throughout.

The constituent elements of the eruption were pa]>ul:ir, with or

British Journal of Dermatology.)

Vol XX, No. 1.

i^>

To ILLUSTRATE DR. STOWERS'S CaSE OF CONGENITAL ICHTHYOSIS HYSTRIX LINEARIS.

British Journal of Dermatology.]

IVOL. XX. No 1

To 'illustrate Dr. Stowers's Case of Congenital Ichthyosis hystrix linearis.

^•ib

<^*^^

Site?

CONGENITAL ICHTHYOSIS HYSTRIX LINEARIS. 3

without scales. These increasing became more raised, exuberant and
indurated outgrowths cuhninating in hirge warty developments and
spiny prominences. Of these some were single and discrete, some
multiple and massed together, while others were compressed into
groups, the several corneous growths being separable at their
extremities but attached to a coherent base.

In some parts normal skin could be seen between the excrescences
when separated.

The most confluent of the cutaneous asperities existed upon the
arms and right buttock, where circumscribed patches or plaques were
present, but the linear arrangement was conspicuous upon the riglit
arm, the left forearm, and most particularly the inner side of the left
thigh, extending from the genitals to the knee in a narrow band-like
form.

Parallel streaks were visible upon the upper arm, and the contig-uous
surfaces of the index and second fingers of the left hand were
involved.

The papillary elevations, varying in size, were especially massed
together on the arms, forming large groups of warty outgrowths, but
their horn-like character was most marked on the right forearm, hands,
and lower end of the band on the inner and posterior surface of the
left thigh, where, either single or multiple, they projected from the
surface to an extent exceeding half an inch in length.

As is common to almost all the recorded cases of this disease the
eruptive elements occurred in the form of bands or streaks correspond-
ing to the long axis of the limb affected, and also transversely across
the axis of the body, either continuously or in an interrupted manner
with normal skin intervening.

The parallel streaks or ribbon-like bands were well seen in the
accompanying illustrations.

In addition patches or plaques were visible upon the trunk. The
growths upon the body, although less marked and flatter than on the
limbs, covered considerable areas, and had a somewhat circular or
semicircular arrangement. There had been no bleeding or ulceration.

I was informed that at the time of birth red markings were seexi
on the left foot, and numei'ous " spots '' also, corresponding with the
positions in which the growths developed upon the body and limbs.
The face, neck, and scalp were, and always had been, free.

4 AETIOLOGY OF INFANTILE ECZEMA.

The patient was admitted into hospital for the removal of several
of the growths, and skin grafts were made on the sites of excision.
She also underwent the necessary operation for correction of the
talipes.

Attention should be drawn to a case of Ichthyosis hystrix, in many
respects corresponding to mine^ published by Dr. Philip Gr. Borrowman,
of Crieff, in the June number of the Scottish Medical and Surgical
Journal. It is illustrated by photographs which show the distribu-
tion of the disease very clearly. The two cases may well be studied
together.

A FURTHER NOTE ON THE ETIOLOGY OF INFANTILE

ECZEMA.

By ARTHUR J. HALL, M.A., M.D.Cantab., F.R.C.P.,

Physician, Sheffield Boyal Hospital ; Lecturer on Morbid Anatomy,
University of Sheffield.

In the British Journal of Dermatology (May to August, 1905), I
recorded somewhat fully the details of sixty consecutive cases of
infantile eczema, examined with the object of ascertaining something
definite as to the getiology of this well-defined and easily recognised
type of eczema.

The results thereby obtained seemed to make it desirable to
continue this inquiry in order to see Avhether any of the results
previously obtained would be confirmed or otherwise by extending
the number of cases examined. The original series numbered sixty
cases ; since then forty more have passed through my hands, and the
opportunity seems a suitable one for presenting briefly the statistics
of these hundred cases of infantile eczema.

The chief points laid stress upon in the former article have, in every
particular, been fully supported by the further cases under observa-
tion. Briefly, they are as follows :

N. B. — I have defined infantile eczema for the purpose of this
inquiry as eczema beginning during the first year of extra-uterine life.

I. Of the Primary Site of tlie Eruption.
(1) The primary site of the eruption is almost always on some part
of the scalp or face. It always becomes bilateral and is usually
.symmetrical.

/ETIOLOGY OF INFANTILE ECZEMA. 5

(2) It is usually most severe in or about the region of the primary-
site.

(3) Other parts, the body and limbs, are frequently affected.
This may occur earlier or later. It is usually much less severe in
these parts, at any rate until later in the disease.

(4) Certain parts of the face and neck frequently, but not always,
remain clear.

II. Of the Age at which the Rash Appears.

(1) It is most common about the third or fourth month of life.

(2) It may appear within the first week.

(3) About four fifths of the cases occur dui-ing the first four
months of life.

III. Of the Season in lohich the Rash First Appears.
(1) It is much more prevalent during the colder months than the
warmer. Only seven out of one hundred cases began during the
summer quarter — June, July, August.

IV. Of the Sex.

(1) There is a preponderance of males affected over females (78
per cent, to 22 per cent.).

(2) This preponderance is greater than can be accounted for by
the difference in birth ratio of the two sexes.

V. Of other Children of the same Family Affected.

(1) In most cases the brothers and sisters are not similarly affected,
even in large families.

(2) Exceptionally, one or even two other children of the same
parents are similarly affected.

VI. Of the Age of the Mother.
(1) There is no clear evidence that the mother's age when the
child is born plays any part.

O AETIOLOGY OF INFANTILE ECZEMA.

VII. Of the Relation of Vaccination to the First Appearance of the

Eruption.

(1) There is no evidence of vaccination as an jetiolog'ical factor in
the causation of infantile eczema.

(2) The number of cases in Avhich the eruption follows vaccination
is less than one third of the whole.

(3) The period at which it has followed vaccination is extremely
variable, from forty-eight hours up to two, three, six, or even nine
months.

(4) Occasionally the coincidence is very striking.

YIII. Of the Relation of First Dentition to the First Appearance of

the Eruption.

(1) There is strong evidence that first dentition has no ^etiological
connection with infantile eczema.

(2) In over four fifths of the cases first dentition had not begun
when the rash first appeared.

(3) The two events occasionally coincide.

IX, Of the Relationship of Gastro-intestinal Disturbances to the First
Appearance of the Eruption.

(1) Vomiting does not occur in more than a small percentage of
cases.

(2) Diarrhoea does not occur in more than a small percentage of
cases.

(3) There is not often any complaint as to the child 'taking badly"
at the time of the eruption.

X. Of the Nutrition of the Child,

(1) There is no evidence of rickets in most of the cases.

(2) When present, it is usually after the eruption has lasted a
long time.

(3) There is very rarely any wasting at the appearance of the
ei'uption.

.ETIOLOGY OF INFANTILE ECZEMA. 7

XI. Of Skin-disease, Past or Present, hi the Mother.

(1) In three quarters of the cases there is no evidence of skin-
disease, past or present, in the mother.

(2) In only 12 per cent, had the mother suffered from definite
eczema.

Statistics of 100 Cases of Infantile Eczema.

(a) Sex.

Per 100 cases

Males
Females

78
22

100

Note. — From the figures kindly supplied me by the Medical Officer
of Health (Dr. Scurfield), the relative percentage of male and female
births in this district during the corresponding years is males 50*8,
females 49-2.

{h) Age of Mother at Birth of Child.

In 100 cases :

Under 25 years of age
Over

Affe not stated

100

n 100 cases :

Affected child first born

}}

second born .

})

}}

third born

)}

later born

Not stated

100

.ETIOLOGY OF INFANTILE ECZEMA.

(d) Evidence of SJdn-disease in Parents.
In 100 cases :

Mother has had definite " eczema "
„ „ vague " skin-disease "

„ „ no skin-disease .

In 100 cases :

Father has had definite eczema .
„ ,, not had definite eczema .

28
60

100

N.B. — Mother personally examined in each case. Father not
examined.

[e) Evidence of Skin-disease, Past or Present, in other Children.
Of 209 other children of these families :

Had definite eczema ..... 10
Never had definite eczema .... 199

209

(/) Age of Child when the Rash First Appeared.

100 cases :

Rash first appeared during first month

„ „ second „
}} }} third „

30 h^

„ „ fourth ,,

29>

fifth „
„ „ sixth month or later .

12J ^^

Date not given

1 1

100 100

[g] Site on which Eruption First Appeared.
In 100 cases :

On cheeks, forehead, or temples . . 56]

„ scalp or ears . . . . . 40 J

Elsewhere ..... 4

100

AETIOLOGY OF INFANTILE ECZEMA.

{h) Season of Year ivhen Rash First Appeared.

In 100 cases :

Months.

January .

September

February

October

March

November

April

December

May

June

Not stated

July

August .

14
10
11

100

In 100 cases :

Quarters.
December^ January, February
March, April, May
June, July, August
September, October, November
Not stated .

35
24

100

{i) Nature of Food at First Appearance of Eruption.
In the total 100 cases (less one in which there is no statement)
there are :

Breast-fed only . . 57^

Breast-fed chiefly . . 26 J
Bottle-fed entirely . . 16

No statement . . I

100

{j) The Relation to Vaccination.

In 100 cases :

Vaccination preceded rash

„ did not precede rash

{Vide note in previous paper.)

100

10 ETIOLOGY OF INFANTILE ECZEMA.

[k) Relation of First Dentition to First Appearance of Rash.
In 100 cases :

First dentition preceded rash ... 12

„ „ had not begun when^

„ ,, rasli appeared j

Not stated ... 5

100

(l) Gastro-intestinal Disturhances .

In 100 cases :

Vomiting :

Present in . . . . . . 11

Absent in ...... 81

No statement ..... 8

100

Diarrluea :

Present in . , . . . . 13

Absent in ...... 81

No statement .... 6

100

Nutrition : Rickets :

Present (definitely or doubtfully) in . 30

Absent 58

No statement . . . . 12

100

It is not necessary to repeat the conclusions given fully in my
previous article, seeing that the points there laid stress upon have
been in every respect confirmed by this further series of cases. I
would merely emphasise the striking manner in which the head or
face is the part first afl^ected in 96 per cent, of the cases, whereas
this is by no means a common primary site of eczema at any other
period of life.

KOYAl, SOCIETY OK MKDK'INJ;. 11

8iieli a unit'urmity of priuiavy situiitiou at least suggests a dimin-
ished local resistance to ordinary external irritants of daily life, or
the presence of some local irritant at that point. There is no parti-
cular local irritant, whilst the fact that only 7 per cent, of the cases
began during the summer quarter seems to support the view that
exposure to cold winds may be the common external irritant.

But thei'e is necessarily a good deal more to be ascertained before
the eczema can be explained. That, however, is equally true of
every case of eczema produced by any irritant. But if we can be
satisfied that infantile eczema is precipitated by external irritants, it
is at least likely to be of value both for its pi'evention and treatment.

EOYAL SOCIETY OF MEDICINE.
DERMATOLOGICAL SECTION.

A MEETING of this Section was held at 20, Hanover Square, on
Thursday, December 19th, 1907, Dr. T. Colcott Fox, Vice-President,
in the Chair.

The following cases and specimens Avere shown :

Mr. G. AV. Dawson showed a case for diagnosis. The patient was
a young woman, aged 33 years, of healthy appearance, with a
peculiar condition of the extremities. It began about six years
ago on the palms of the hands and soles of the feet, where it
remained limited for nearly two years. Since then it had extended
up to the middle of the forearms and legs, being fairly well demar-
cated from the sound skin. It was of a brownish colour, and the
numerous lines Avhich intersected one another, as well as the rough-
ness which was present, gave it the appearance of crocodile leather.
There was, however, no appreciable thickening, no evidence of the
follicles being involved, and no itching. Besides this condition she had
patches of a psoinatic-looking eruption on the patellae and elbows.

The eruption, which had never been moist and was of a remarkably
uniform appearance, did not appear to correspond to any described
condition.

Dr. Colcott Fox exhibited a robust-looking married woman, aged

12 EOYAL SOCIETY OF MEDICINE.

25 years, Avitli four dissemiuated vegetating gramdomata on the face
of three montlis' duration. She had one healthy child and was pregnant
with a second ; no iniscarriages. Four lesions existed, said to have
begun as " pimples/' and were gradually enlarging. The patient said
they evolved after a severe cold and sore throat. One lesion, the size
of a split-pea, was seated on the bridge of the nose and was the first to
form ; a second, the size of a f ourpenny-piece, occupied the naso-geneal
furrow and adjoining surfaces ; a third and fourth were rather smaller
and seated respectively on the left upper lip and the left chin. These
lesions were rounded, granuloma-like infiltrations, surmounted by
marked vegetations, not florid and vascular but warty in aspect.
There were no miliary abscesses from which pus could be squeezed
out. Two other lesions grew on the left cheek and chin, but had
disappeared, leaving scars.

Although the nature of the disease had not yet been thoroughly
investigated. Dr. Fox thought the clinical aspects alone were of
interest, and, moreover, the lesions Avere already markedly subsiding
under the influence of the internal administration of mistura
hydrargyri biniodidi.

As to the differential diagnosis, the exhibitor said no iodides had
been taken prior to the evolution of the eruption. The eruption was
innnediately preceded by what the patient described as a bad cold
and sore throat, but there was no history of any widespread eruption.
Moreover, vegetating syphilides and tuberculosis of the face were
usually of the florid f ramboesioid type, and not warty like the verrucose
tuberculosis of the back of the hand. There was no chronic coccic
inflammation as in sycosis to account for the vegetating lesions.
Clinically the eruption was very similar to those described in
blastomycosis.

Dr. Graham Little showed (1) a case of favus of the scalp in a
woman, aged 40 years, who had had the disease since early child-
hood. She was an Englishwoman, a native of Essex, had never lived
abroad, and the origin was doubtful. The scalp Avas almost entirely
denuded of hair, old cicatricial atrophy having resulted from the
favus ; but there was active disease over a large part of the scalp,
and absolutely typical scutula were present in this area. The fungus
had been readily demonstrated in the hair. This patient had a

KOYAL SOCIETY OF MEDICIM]. 13

diseased nail of (nie fing'er, tlie eiuunel being" destroyed and the nail
giving the appearance of " moelle de jonc " which has been described
by Frencli authors as typical of favus. Doubtful fragments of
mycelium had been seen in scrapings fi'om the nail,

(2) A second case of favun of the scalp in a boy, aged 8 years, the
nephew of the preceding case. This patient had had the disease
since early infancy, but it had spi*ead of late. There were no scutula
at all, and the scalp showed circinate, red, pityriasic patches with very
little hair in the aifected part. Fungus had been seen in one hair
after many fruitless examinations.

(3) A case of Bazin's disease {Erythema induratiiin) in a young
woman. Nodose swellings had appeared about six weeks or two
months previously. These were painless, deep blue, infiltrated and
numerous on both legs and both feet. She gave the history of
previous similar swellings which had left some permanent scarring.
There was no tubercular history, and the patient herself, thoug-h
anaemic, showed no sign of tuberculosis. Her opsonic index had
been estimated on one occasion only, and was then "96. The sudden-
ness with which the swellings had appeared had at first suggested
Erythema nodosum, but they were painless, and had now persisted
beyond the time limits of Erythema nodosum. It might be considered
too rapid in development for Er3^thema induratum, but with this
exception the diagnosis of that disease would better fit in with the
symptoms than any other affection.

Dr. J. M. H. MacLeod and Mr. Treacher Collins (introduced)
showed two cases of advanced " Keratosis folUcularis associated
vith baldness'' in two brothers, aged respectively 13 and 10 years.
The two cases and that of an elder brother similarly affected, whose
photograph was shown, first came under the observation of Mr.
Collins in 1902, at the School of the Metropolitan Asylums Board,
at Swanley, as all the three boys were suffering from trachoma.
The cases were sent up to Dr. MacLeod's clinic at Charing Cross
Hospital, in August, 1907, when the following notes were taken :

(1) William B — , aged 19 years, suffering fi-om Keratosis folUcularis
associated icith baldness, and trachoma.

The patient Avas a fairly well-developed lad whose general health
was good. He was the eldest of five brothers, two of the others

14 EOYAL SOCIETY OF MEDICINE.

being affected with the same condition of the skin. All the regions
of the body where hairs occurred, with a few exceptions, were
covered with small, pin-head sized papules arranged in groups or
diffusely distributed. The papules were follicular and surmounted
by conical, horny plugs or spines about 2 mm. in length, and where
they were most marked they gave to the skin the feeling of a nut-
meg-grater. On picking out the horny plug a central depression
was left. The papules were not situated on an inflammatory base,
and except for slight scaliness in certain situations the skin between
them seemed to be normal. The distribution of the papules tended
to be symmetrical. They were most numerous on the extensor
aspects of the arms, the back and sides of the neck, the buttocks, and
on the beard and ciliary regions of the face. On the back and loins
there were a few groups and several disseminated lesions. A few
scattered lesions were also present on the abdomen, but there were
none on the chest, though many of the hair-follicles were more
visible and palpable than normally. Lesions were absent from the
extensor aspects of the legs and part of the face, and in these
situations the skin was rough like ichthyosis. A small group of lesions
was present on the dorsum of the hands, but none occurred on the
backs of the fingers. They were present, however, on the dorsal
aspect of the toes. The eyelashes and eyebrows were absent but the
hair of the scalp was unaffected.

The skin generally felt dry and harsh though the patient perspired
freely in warm weather and after physical exertion. The hands were
cyanosed and felt cold. There were no subjective symptoms such as
itching associated with the lesions.

At birth the skin appeared to be normal, but when an infant in
long clothes he was taken to Westminster Hospital for advice regard-
ing his skin and eyebrows. His eruption is said to have begun on
his face and eyebrows. He had measles when he was five months old
and the eruption spread rapidly afterwards.

The patient has had trachoma since he Avas five years old, on
account of which he had to be removed from school as he suffered
acutely from photophobia.

The family history showed that the father's family suffered from
pulmonary tuberculosis, the father himself not being aff'octed, but the
details of the family history were not obtained.

KOYAL S0CII:TY OF MKIHCIXE. 15

(2) Alfred B — , aged 13 years, with Kt'rato.sis follicularis. The
patient presented a similar condition of the skin to William's, but the
lesions were less abundant and niore scattered. In this case the
front of the chest was not exempt, but only the chin was affected on
the face. The backs of the hands were more involved and spiny
lesions were present on the backs of the fingers. The skin of the
extensor aspect of the legs, the front of the knees, and the elbows
was ichthyotic. In this case the scalp was markedly affected and
was almost totally bald, only a few downy hairs being present on
the sides of the head. The scalp was red in front and rough and
scaly. The boy was born healthy and the affection was first noted
when he was about two years of age. At the age of seven much
of the hair had come out in patches at the back of the scalp, but
was present then in front; the eyebrows and eyelashes had gone.
The patient has suffered from trachoma since birth.

(3) Leonard B — , aged 10 years, with Keratosis follicularis. The
patient was similarly affected to Alfred, but in a milder degree. His
scalp was only partially bald, a few tufts of normal hair being left at
the sides. The patient never had much hair on the scalp. The eye-
brows and eyelashes were involved and absent. The patient was born
healthy. It had begun during his first year, and at the age of two
years the skin was rough and the hair had gone from the head. He
also suffered from trachoma.

A histological examination was made of several well-marked, spiny
lesions excised from the back of the neck in the case of Alfred B — ,
and sections were exhibited. These showed that the mouths of the
follicles were dilated and filled with a horny plug*, occupying the
whole of the funnel of the follicle and extending about 1 mm. above
the level of the skin. The stratum corneum in the neighbourhood of
the follicle showed slight hyperkeratosis, the deeper layers of the
epidermis not being noticeably affected. The deeper portion of the
follicle was somewhat shrunken and in one or two of them the
remains of an atrophied hair were detected. The sebaceous glands
were absent. Sweat-glands were present and appeared to be healthy.
Around the follicles there was a slight cellular infiltration of small
rounded cells, but the connective-tissue bundles in the neighbourhood
of the follicles were not rarefied and there was no definite evidence of
inflammation.

16 EOYAL SOCIETY OF MEDICINE.

The important features of all three cases were : (1) The plugging of
the hah*-follieles with horny spines over certain regions of the body,
being most marked on the face, scalp (in two cases), back of the neck,
extensor aspect of the arms and buttocks, but occurring also to a
greater or less extent in all situations where hair-follicles existed,
and leading to loss of the eyebrows and eyelashes in all the cases,
and almost complete baldness in two of them.

(2) The association of the spiny follicles with general dry and
harsh condition of the skin of the type of xerodermia or a mild
degree of ichthyosis.

(3) The fact that the condition appeared first in two of the cases
during the first year and in the other before the end of the second,
all three being reported to have been born with healthy skins.

(4) The absence of definite evidences of inflammation having pre-
ceded the growth of the spiny papule, and also the apparent absence
of atrophic changes.

The cases suggested an ichthyotic condition in which the mouths
of the follicles were specially involved. In some respects they corre-
sponded to cases which have been described by Brocq under the
heading of " Keratosis pilaris " and by Unna as " Keratosis supra-
follicularis," differing in the fact that the eyebrows, eyelashes, and
scalp were so markedly involved. The absence of atrophy distin-
guished them from the cases described by Taenzer with the title of
" Ulerythema ophryogenes."

Mr. Tkeacher Collins said that there was little for him to add to
Dr. MacLeod's description. The cases came to him on account of
the almost intractable condition of their conjunctivse, and they had
been under his observation four years. They were suffering from
trachoma when they were first seen by him, and that was now almost
cured, but the children still had recurrent attacks of conjunctivitis.
He believed that their conjunctivaB were inoculated by means of the
handkerchief from their nasal discharge, the absence of eyelashes
making it easier for the conjunctivaB to be infected. The condition of
the skin had not altered during the four years they had been under
his observation.

Note. — A detailed description of the cases will be published in a future issue
of the journal.

Dr. J. M. H. MacLeod showed a case of Erythema indnratum

ROYAL SOCIETY OF MKDiriNE. 17

{Bnzin) in a woman, aged 21 years, iti wliicli a positive oplitliahno-
tubereuliii reaction had been obtained. The patient was a somewhat
delicate-looking young woman who worked as a milliner. She had a
tuberculous family history, two of her aunts on her mother's side
having tuberculosis of the lungs. Three years before she came under
the exhibitor's observation lesions of Bazin's disease made their
appearance on both legs. These were scraped, but new lesions
developed later. At the time of exhibition she presented a number
of lesions on both legs consisting of the typical ulcers, reddish-purple
patches, deep-seated nodules, and the scars of former lesions. She
had no other evidences of tuberculosis. On December 10th a drop
of Calmette's tuberculin solution, freshly prepared from the powder,
was di'opped in the conjunctiva of the right eye near the inner
canthus, the eyes having been examined beforehand and proved to
be healthy. Six hours later the eye became inflamed, and when she
was seen twenty-four hours afterwards an acute reaction had taken
place, the lower conjunctiva and the caruncle being red and injected,
and an exudation had collected in the inferior conjunctival sac. The
eye was so extremely painful and there was such a degree of photo-
phobia that a drop of adrenalin (1 in 1000) and cocaine, 2 per cent,
solution, was prescribed every six hours to relieve the pain. This
reaction in the eye was accompanied by a local reaction in the lesions
in the leg, which became definitely painful and appeared to be more
vivid in colour. The ophthalmic reaction persisted at its maximum for
twenty-four hours longer and then gradually subsided. At the time
of exhibition there were still evidences of it.

The Chairman remarked that some years ago lie had had material from a
case of Bazin's disease inoculated into a guinea-pig, and the animal had died of
tuberculosis. He did not publish the case.

Dr. Stowers exhibited for a second time the male patient, aged
48 years, who was the subject of an infective gramdoma of the right
cheek of septic origin, for the purpose of showing the effects of treat-
ment. The tumour (a description of which has been recorded in the
Transact ions), had greatly diminished in size, and was still undergoing
a process of resolution. It was decided to continue the mercurial
application until the skin had resumed its normal condition.

VOL. XX.

18 CURRENT LITERATURR.

CURRENT LITERATURE.

TO THE KNOWLEDGE OF URTICARIA PIGMENTOSA. C. BOHAC.
{Arcliiv f. Derm. u. Syj^h., October, 1906, p. 49.)

The patient was a slater, aged 40 years, who came under observation at
Professor Pick's clinique at Prague, in January, 1904, suffering from Ui-ticaria
pigmentosa. There was no history of a similar condition in his family. The
disease was first noticed by the patient's wife when he was 27 years of age
who thought the lesions were birth-marks and occurred on the back. They were
painless, and were not accompanied by itching. They next appeared on the
extended aspect of the upper extremities, neck, knee, foot, and in 1903 on the
forehead. As they gave rise to no subjective symptoms the patient only
discovered new ones when he looked for them. The lesions varied in colour
from day to day, tending to be paler in cold weather and redder in warm weather
or when pressed as by a hat on the forehead. Fresh lesions appeared as red
spots aljout the size of a pin's head, and gradually increased in size. For two
years the patient had noticed that when he got hot and perspired about the
groins that his skin itched violently, and that if he scratched himself wheals
developed, but these disappeared in a few minutes. At the time of examination
the pigmented eruption was present on the forehead, the neck, the front of the
trunk, and the back, the upper arm, the forearm, especially the flexor aspect, the
thigh and the leg in the neighbourhood of the malleoli, and on the l^ack of
the feet.

The lesions were all of the same type, though they differed in size, colour,
and grouping, and in the degree in which they were raised above the sux-rounding
skin. They were sharply demarcated, tended to be oval in shape, and were
brownish-yellow in colour. Factitious urticaria was noted on the chest
and back.

For histological examination a piece of skin which included two oval brownish-
yellow lesions which were definitely raised and infiltrated was excised from the back.
This was fixed in alcohol and embedded in paraffin, and the sections stained for
mast-cells. The stratum corneum over the lesions showed evidence of parakeratosis.
The Malpighian layer was markedly cedematous, the interepithelial lymphatics
being dilated, and with leucocytes present in the spaces. The cells of the basal
layer and the layer immediately above it were deeply pigmented, the pigment
being in the form of very small golden-yellow or brown gi-anules situated in the
cells, chiefly at the end farthest from the corium. In addition to the pigmenta-
tion a number of the cells of the basal layer showed a vacuolated degeneration.
The amount of pigment in the epidermis corresponded to the degree of patho-
logical change in the underlying corium, for where the infiltration in the cutis
was densest there the i)igmentation above it was most intense. The most
marked change in the corium was the presence of the numerous mast-cells, either
disseminated or collected together, forming a " mast-cell tumour." Besides the
mast-cells, in the neighbourhood of the blood-vessels a niimber of fixed connective-
tissue cells and fibroblasts were noted. Pigmented cells were also present, and
deposits of pigment between the mast-ceUs. Near the blood-vessels a few mono-

('iii;i;i;nt ijtkkatiikm. 19

mu'loar leiu-ooytes were ubserved. Xo iiiurplioloyical change was detected in
the ehistic tissue.

The chief peculiarity of tlie case was tliat it first appeared at the age of
27 years. J. M. H. M.

A CASE OF LYMPHANGIECTASIS WITH LYMPHOREHGEA.

0. MuLLER. (Archiv f. Derm. u. Syph., October 1906, p. 111.)

The case which forms the basis of this contribution was one of circumscribed
lyniphangiectasis of the scrotum and elephantiasis of the left leg. The patient
was a young man. aged 20 years, who had suffered from the affection for three
years. It had begun with severe pain on the inner aspect of the left thigh ; this
was followed after some time by redness and swelling of the part, and the
appearance of a small red spot, from which clear fluid began to ooze out. The
scrotum next became swollen and a number of vesicles formed on it, from which
weeping occurred several times a day. Gradually the affected skin and scrotum
became markedly thickened and infiltrated, and a large number of tumours,
varying in size from a pin's head to a pea, developed on it. The largest of these
had a glassy appearance, or suggested cooked sago grains. "When these were
punctured a clear fluid oozed out continuously for several hours. The general
health of the patient remained unimpaired. A histological examination of a
piece of tissue excised showed a marked lymph-stasis and dilatation of the
lymphatic vessels of the corium and subcutaneous tissue. The small veins of the
skin were also dilated and filled with blood. The writer did not arrive at any
conclusion with regard to the cause of the affection, l:)ut suggested that it might
possibly be due to some congenital anomaly of the lymph -vessels, but was more
probably the result of an inflammatory process affecting the underlying tissue.

J. M. H. M.

ON THE RELATION OF THE SPIROCHJETA PALLIDA TO CON-
GENITAL SYPHILIS. A. Buschke and W. Fischer. {Archiv f. Derm,
u. Sijph., October, 1906, p. 63 ; three plates.)

The wi-iters refer first in this paper to Shaiidinn and Hoffman's description of
the spirochsete. They note that in spite of the great mass of literature dealing
with control experiments, in which the Spiroclv^ta paUida has been sought for
in other conditions than syphilis, the only instance in wliich a spirocha^te similar
to the Spiroclia'ta pallida was detected was in Castellani's case of yaws. They do not
regard the instances in which it has been described in carcinoma and other tissues
as conclusive, and doubt if the spirochsete found in such cases was the Spiroclneta
pallida. They next describe various methods of staining the spirochsete in the
tissiies, with special reference to Levaditi's, by means of which they examined the
tissues from five cases of congenital syphilis.

Case 1 died at ten weeks of age, the whole body being covered with a papular
eruption. Spirochxta pallida was found in great quantity on the spleen and liver,
and on the skin. In the latter situation spirochsetes were present in great numbers
in the papillse about the capillaries. They also occurred between the cells of the
sweat-glands and those of the sebaceous glands, and seemed to spread from place
to j)lace on the skin along the lymphatic spaces. In Case 2 the infant died at four
weeks of age. The spirochsetes were found in the liver and spleen in large numbers.

20 CURRENT LITERATURE.

A few were found in the perivascular infiltration and connective tissue of the
kidneys. Case 3 was born dead, and the liver, lung, kidney, and spleen were
examined for spirochsetes with positive results. In the liver and lung spirochetes
were observed in certain large leucocytes. This was the first occasion in which
the writers had noted the presence of the organisms within cells. Case 4 was a
congenital syphilitic child which died when fom- weeks old. A few days before
death a well-marked papular syphilide was noted and a general adenitis, and one
of the papules was excised and spirochsetes were found in it. They were chiefly
located about the capillaries, hair-follicles, sweat-glands, and interfilirillary
spaces. The organism was also foimd in the serum from a blister artificially
produced by cantharides.

Case 5 had a syphilitic mothei-, who was suffering from active syphilis, liiit at
the time of hivth the infant showed no trace of the disease, and was well developed.
When the child was a month old the blood was examined and found to contain
spii'ochsetes. A few weeks later the child died.

The writers conclude by referring to certain of their researches with regard to
the situation in the tissues of the spirochsetes in acquired syphilis. They found
them in the lumen of the blood and lymph-vessels, and on the walls of the vessels.
The syphilitic cellular infiltration also contained numerous spirochsetes.

J. M. H. M.

A FURTHER CONTRIBUTION ON LINEAR ERUPTIONS. L. FiscHEL
and A. Blaschko. (Arcliiv f. Derm. u. Syjili., November, 1906, p. 209.)

The writers describe a case of a linear eruption which occiu-red in a woman,
aged 49 years. The skin-afBection was preceded by a slight rise in temperature
and marked itching of the skin of the left side of the thorax in the axillary line
between the sixth and eighth ril^s. Soon afterwards a red patch developed, which
was followed by the appearance of a linear streak, about two fingers' Ijreadth, and
extending upwards and outwards from the umbilicus and round on to the back.
A week later a streak appeared on the left buttock and extended down the
posterior aspect of the thigh, aci-oss the popliteal space, and downwards and
inwards over the calf. This was also ushered in by itching and burning. Four
weeks after the streaks had ajspeared they underwent spontaneous involution.
The elements of the eruption consisted of small nodules and vesicles on a red and
slightly swollen surface, with here and there scaly lesions and lichenification.
The leading features of the eruption were : (1) that it was sharply unilateral ;
(2) that before the appearance of the eruption there was slight fever and itching
of the skin similar to that which may occur in Her^Des zoster ; (3) that the erup-
tion rapidly and completely disappeared without treatment ; and (4) that with
its disappearance a certain degree of atrophy of the lower extremity occurred.
On consideration of these characteristics the writers concluded that they had to do
with an affection of the central nervous system, and that the condition of the
skin was secondary. The part of the nervous system affected seemed to be the
seventh to the tenth dorsal segments and the first three sacral segments (Head),
and that the special part involved appeared to be the posterior roots.

J. M. H. M.

CUKK'KNT LlTKIJATUliH. 21

HISTOLOGICAL STUDY ON THE PRESENCE OF THE SPIRO-
CH^TA PALLIDA IN TISSUES. K. Sakurane. {Arcldv f. Derm.
u. Syph., Xoveiuber, U'Otl, p. '2'2~.)

Under the direction of Pvofessor Neisser the writer has examined hy Levaditi's
methods a variety of tissues from cases of con<,'enital and acquired syphilis for
the presence of Spiiochxta pallida. As a control he also examined, by the same
methods, tissues from non-syphilitic affections. Nine cases of hereditary syphilis
Avere examined. In Case 1 (a congenital syphilitic infant which died at the age
of one month) the spirochaetes were found in the lungs, kidneys, supra-renals ;
in Case 2 (syphilitic infant, died when five weeks old) the spirochetes were found
in the lungs, liver, and kidneys ; in Case 3 (syjDhilitic infant, died when two hours
old) they were found iu the lungs and testicles ; in Case 4 (syphilitic infant, died
fourteen days after birth) they were noted in the lungs, liver, spleen, and Ijone-
marrow ; in Cases 5 and 6 (foetus of four and a half months, and foetus of six
months) the search in the organs for the spirochsete gave negative results ; in
Case 7 (a six months' dead-born foetus) spirochsetes were foimd in the lung, liver,
spleen, kidney, supra-renal, and umbilical cord ; in Case 8 (a dead-born foetus of
six months) spirochcetes were found in the lungs, liver, kidneys, and spleen ; in
Case 9 (a macerated foetus of six mouths) spirochtetes occurred iu the limgs, livei-,
kidneys, and testicles.

With regard to acquired syphilis, the spirochaites were only found in the condy-
lomata, and in nine cases positive results were obtained, all the cases being
untreated j)revious to the examination. The spirochaetes were present in the
cellular infiltration in the neighbourhood of the blood-vessels. They also occurred
in the lumen of the vessels ; they were specially prevalent in the papillae and
between the cells of the epidermis immediately above the papillte. Besides the
Spirochxta pallida Siiey? oi the Spirochseta refringens were noted. The tissues
examined for spirochaetes as a control consisted of the lung of a child which had
died of cataiThal pneumonia, a Pemphigus foliaceus, a Herpes zoster, a soft sore,
a tumoixr of Mycosis fungoides, and a skin carcinoma, and all w^ith negative
results.

The spirochaetes were chiefly situated in the tissues outside the cells and about
the blood-vessels, and seemed to be earned along the blood-stream. Only occasion-
ally were they detected within cells.

J. M. H. M.

MULTIPLE ENDOTHELIOMA OF THE SCALP. P. Haslund.

(Archiv f. Derm. u. Syph., November, 1906, p. 247, and December, 1906,

p. 323.) '
Beyond the cases of this rare affection recorded by Mulerts, Spiegler, and
others, so little is known regarding it that the waiter considered a case which
came under his observation at Copenhagen to be worthy of recording in detail.

The patient, a nervous woman, aged 48 years, was fii'st seen by the wiiter in
June, 1903, at the Kommune Hospital. The affection had begun a year before
wath the appearance of a nodule on the left parietal region, for which she could
assign no cause. Six months later several similar lesions developed in the scalp.
At the examination a roxmded tumom* about 3 cm. in diameter, with necrotic

22 CURRENT LITEKATURE.

ulcerating surface, was noted on the left temporal region. A similar lesion,
about double the size, was present on the occiput. A number of smaller
tumours, varying in size from a split-pea- to 5 cm. in diameter, were also scattered
over the scalp, and tended to coalesce to form an irregular partially ulcerated
patch. All the lesions were of the same natiu-e. and were situated in the deeper
layers of the skin. They were somewhat hard in consistence and incompressible.
The surface of the smaller lesions was quite smooth, while that of the larger
ones was tuberciilated, and the hair was absent from it. In colour it was
reddish, with bluish vessels over it, or of a deep black colour from necrosis. On
puncturing the lesions no fluid was obtained. The lesions were painful on
pressure. The patient was admitted to the Friedrich's Hospital. A lesion
on the nape of the neck was treated by X-rays, which resulted in a
distinct flattening of the tumoiir, and various other forms of treatment were
adojDted. The tumours, howevei*. began to break do-mi in spite of treatment, the
pain in them increased, and the patient died in hospital in February of the following
year. During life two small pieces of lesions were excised for histological
pui-poses, and showed the following characteristics : The tumour-mass was
situated in the corium and sultcutis ; the epidermis over it was atrophied, and
showed no tendency to proliferate at the sides. The tumour-mass had an
alveolar structure, being made up of groups of cells separated by bundles of
connective tissue of varying thickness. The cells were large, oval, or polygonal
in shape, and rich in jDrotoplasm. with correspondingly large vesicular niiclei
occasionally presenting mitotic figures. Some of the cells had the appearance
of endothelial cells. The lymphatic spaces were much dilated and filled with
tumour cells. In a few places there was a definite proliferation of the endothelium
of the lymi)h -capillaries. The l^lood-vessels, on the other hand, appeared to be
normal. Everything pointed to the tumour being a lymph caj)illary-endothe-
lioma. The paper is illustrated by a photograph of the patient and a series of
drawings showing the histological characteristics.

J. M. H. M.

ON LICHEN ALBUS, A PREVIOUSLY UNDESCRIBED AFFECTION.

R. VON ZuMBUSCH. (Archiv f. Derm. v. Sj/j:)/;., December, 1906, j). 339.)
In December, 1905, a woman, aged 51 years, came to Professor Riehl's clinic at
Vienna with a peculiar dry, scaly affection of the skin situated chiefly on the flexor
aspect of the forearms, the neck, shoulder, and back. The primary lesion seemed
to be a round or polygonal, slightly raised papule, about the size of a pin's head.
It was rose or lilac coloured and the surface was shiny, not being covered with
scales or crusts. Larger lesions, up to the size of a sixpence, were also present.
These were rounded in shajje and tended to coalesce to form iwlycyclical patches.
These patches were all well demarcated, the border being of a violet tinge like
the primary efflorescence, while the centre was smooth, shiny, and white, like
porcelain. The lesions lasted a few weeks. Where certain lesions had involuted
a distinct atrophy was observed and slight pigmentation ; others disappeared
without any trace. The only sTibjective symptom was intermittent itching. The
eniption did not react to treatment, such as arsenic internally, except in that
the itching associated with it diminished. A piece of tissue from the left
forearm was excised for histological pxirposos. and the following characteristics

CURKKNT LITERATURE. 23

were detected : The epidermis showed no marked changes. There was slight
tedema. l>ut no definite proliferation. The corium, on the other hand, was
markedly altered. The connective tissue of the papillary and siib-papillary
layers had a homo^'onoous appearance, and the fibrous bundles could only be
detected with difficulty. The cliange was limited to the efflorescence, and
accounted for its whitish tint. There was a round-celled, inflammatory infiltra-
tion at the outskirts of the pathological area, while in the centre of it no infil-
tration of cells was noted. The elastic tissue had disappeared to a great extent
from the diseased patch, but was in normal amount around it. The writer dis-
cusses in considerable detail the diagnosis of the case from psoriasis, Lupus
erythematosus and Lichen planus, and concludes that though clinically it
suggests an atypical form of Lichen planus, still the histological appearances did
not correspond to those of that disease or any other known skin-disease, and on
this account he has given it the name of " Lichen albus."

J. M. H. M.

ON THE TREATMENT OF CANCER OP THE SKIN BY THE
X-RAYS. H. Kanitz. [Arclitv f. Derm. u. Smili., December, 1906.
p. 350.)

The employment of the X-rays is indicated in the treatment of the following
types of cases of carcinoma cutis : (1) Superficial forms of epithelioma of the
skin, which are relatively benign ; (2) superficial epitheliomata which involve a
large area ; (3) extensive cases where part is superficial and ijart deep, the super-
ficial areas being healed by the X-rays and the deeper portions subsequently
excised ; (4) inoperable cases, to relieve pain and heal ulceration ; (5) cases in
which a relapse has occurred and the patient is too old and enfeebled to with-
stand further operating ; (6) after operation to prevent or delay recurrences.

According to the writer, X-ray treatment is contra-indicated in carcinoma of
the mucous membrane of the mouth as it is only palliative in that situation, and
should not be employed except in inoperable cases. The paper is illustrated by a
series of photographs of patients before and after treatment. J. M. H. M.

ON N-EVUS AN.ffiMICUS. H. VoRNEK. {ArcMv f. Derm. u. Syph.,
December, 1906, p. 391.)

The name " Nasvus anasmicus " has been given by the writer to a circumscribed,
congenital, cutaneous anomaly, the lesions of which are white macules surrounded
by normal skin. In this contribution he has described four cases of tliis nature.
The white macules varied in size from a linseed to a penny, and had an irregular
border. When the affected skin was rubbed they remained white, while the
surrounding skin assiimed a deep red tint. A microscopical examination showed
a comj)lete or i)artial absence of blood-vessels and of pigment in the lesion.

J. M. H. M.

POLLICUIilTIS (SYCOSIS) SCLEROTISANS. Fr. Samberger. (Archiv
f. Derm. u. Syiih., March, 1907, p. 163.)
The case which formed the basis of this paper occurred in Professor Janowsky's
cUnique at Prague. The patient was an old man, aged 73 years, who had

24 CURRENT LITERATURE.

suffered for upwards of twenty years from a localised, tumour-like affection of
the upper lip, which began as small follicular pustules. The lesion involved the
whole of the lip with the exception of a small strip on the border and a small
area at the left angle of the mouth. It consisted of an in-egular tumour-mass,
of a fil>roiis consistence, which was l)roken up hy deep furrows to form a number
of nodules. The surface was smooth, shiny, and of a red colour. There was no
weeping or papillomatous growth. A few hairs were dotted over it and here
and there were grouped in tufts. A histological examination was made of a
piece of tissue excised from the tumour. This revealed a thinning of the epi-
dermis and flattening of the papillaiy layer. In the corium were evidences of an
inflamn:iatory process involving the upi^er layers, chiefly localised around the
hair-follicles. This resulted in a process of fibromatosis from which originated
the tiunour-mass. The condition belonged to the same category in its clinical
and histological featiires as the aJcne-Tceloid of Bazin, which has been variously
named Nacken-keloid (Unna, Pellizari), FollicuUtis nuchas sclerotisans (Ehrmann),
and Dermatitis papillaris capillitii (Kaposi). According to the wi-iter these are
all variants of the same affection which is a "' simple perifolliciilar or pustular
inflammation of the skin, on the basis of which, in course of time, a growth
occiu-s which is not unlike a keloid." This affection is by no means confined to
the nape of the neck, but, as in this case, may occur in other j)ai'ts of the skin,
such as the upper lip. This keloidal formation the wi-iter believed to be the
result of an inoculation of pus micro-organisms in a predisposed individual.

J. M. H. M.

ON LUPUS ERYTHEMATODES OP THE RED PORTION- OP THE
LIPS AND BUCCAL MUCOSA. Otto Kken. (Ardin^ f. Derm. u.
Sijph., February, 1907, p. 13.)

The fact that Lupus erythematosus may affect the buccal mucous membrane
has been recognised for years and the characteristics of the lesions are too well
known from the writings of Trautmann, Fordyce, Dubreuilh, Roberts, and others
to require a detailed description here. When affected with Lupus erythematosus
the lij)s usually become swollen and assume a purplish-red colour ; later they may
become dry and scaly or eroded and may present an appearance as if they had
been painted over with salicylic collodion. In the mucous membrane of the mouth
the affected surface becomes a vivid red colour with a slightly raised centre, and
here and there presenting telangiectases. Gradually the centre becomes depressed
and assumes a bluish-grey tinge, or may present a whitish scar sm-rounded by an
erythematous halo. The patches vary in size and shape, some being circular and
small, others irregular in outline, wliile occasionally pinkish stripes appear. In
this paper Kren describes four cases. In the first the patient was an artisan,
aged 34 years, and the disease affected the imder-lip and chin. Case 2 was that
of a student, in whom the red part of the under-lip and the neighbouring mucosa
was involved. In Case 3 the patient was a woman, aged 48 years, and the red parts
of both lips were attacked. Case 4 was a woman, aged 48 years, and the buccal
mucosa was markedly affected. After descril)ing these cases in detail the writer
gives a series of short abstracts from the various descriptions of the affection in
the literature. He next describes the liistology of pieces of tissue excised from
Cases 1 and 4, which howed the epithelial proliferation, and the oedema, canali-

CUllUKNT LITKIJATUUE. 25

sation of the tissue, and dense infiltration of cells in the upper layers of tlie
cerium. The paper is illustrated l)y a jjlate showing lesions in the nioiith and
red part of the lip, and the histological structure. J. M. H. M.

ON A NEW NODULAR ERUPTION : LICHEN NITIDUS. F. PiNKUS.
{Archh-f. Denii. u. Siji^h., May, 19U7, p. 11.)

The first case of this peculiar affection, to which the author has given the
name of Lichen nitidus, was observed by him in 1897 while he was assistant at
the University Clinic at Breslau. Since then eight other cases have come under
his observation. The eruption occurred in men. and was usually confined to the
penis, and involved more or less of the skin of the glands and shaft. Occasionally
other parts Avei-e affected, such as the abdomen, chest and arms. It consisted of
small shiny papules or nodules with^a rounded surface, and in many of them
there was a depression in the centre. In consistence they felt like small granulo-
mata, and were hard owing to a thickening of the stratum corneum. They were
about the size of a pin"s head or slightly larger, and though they were very
numerous and close together they never became confluent, and presented a
tendency to be arranged in rows. On histological examination a granuloma
was found in the corium consisting of roimd cells witb epithelioid cells and giant
cells in the centre. The overlying epidermis showed a central thickening, the
centre of which had imdergone parakeratosis. Immediately underneath the
thickened epidermis was a microscopic abscess. On the iinder side of the
epidermis both the basal layer and the pigment were absent. No micro-organisms
were detected in the tissues. Subjective symptoms were absent. The affection
Bad a close resemblance to Lichen planus, but differed from that affection in its
histological structui-e and in the absence of polymorphism in its clinical appear-
ance. J. M. H. M.

SPIROCHETES IN CONDYLOMA ACUMINATUM. Max Julitjsberg.

{Archivf. Derm. u. Sypli., April, 1907, p. 318.)

The wi-iter examined a number of Condylomata acuminata for sioirochagtes in
Professor Neisser's laboratory, employing Levaditi's method, and succeeded in
demonstrating a spirochete in condylomata obtained from a non-syphilitic
patient. The spirochsete was short, thick, and presented f oiu- to eight turns. It was
easily distinguishable from the S. ixdlida, but might have been the S. refringens.
The spirochsetes were situated chiefly in the upper layer of the epidermis in the
secretion on the surface and in the dilated blood-vessels of the corium. Various
other tissues, such as warts, nasvi and other skin-lesions were examined in the
same fashion, but with negative results. J- M. H. M.

TEN CASES OP MYCOSIS PUNGOIDES, WITH REMARKS ON
THE HISTOLOGY AND RONTGEN THERAPY OP THE
DISEASE. K. Hekxheimer and H. Hubner. {Archiv f. Derm. u.
Sijjjli., April, 1907; Neisser's Festschrift, p. 2-il.)

In spite of the large number of cases which have now been recorded there is
stiU much uncertainty -n-ith regard to the aetiology and true nature of this disease,

26 CUEEEXT LITERATUEE.

and the various writers on the subject are at variance as to whether it
should be placed among the infective granulomata. should belong to the
group of the sai'comata, as Kaposi believed, should be regarded as a manifesta-
tion of the " Diathese lymphadeniqxie" of the French school, or should be definitely
considered to be a disease sui generis. In this contribution ten cases of
Mycosis fungoides are described, nine of which occurred in the practice of Dr.
Herxheimer, at Frankfort. These cases are described chiefly from the points of
view of their histo-i^athology and treatment by the X-rays. Biopsies were jjerf ormed
in several of the cases both before and after irradiation. A rt'siime of the histo-
logical chai'acteristics is appended. In all the pieces of tissue examined an
infiltration of cells was foiuid in the deeper layer of the corium, consisting of
small mononuclear " mycosis cells," which the authors believed to be dis-
tinguishable from lymphocytes and regarded as characteristic of the disease.
Plasma-cells and mast-cells were also i^resent in the infiltration, but were sparsely
distributed. In advanced stages of the disease the infiltration spread till it
occupied nearly the w^hole of the corium. The blood-vessels in the diseased area
were in a state of endarteritis, the connective-tissue fibres had undergone hyaline
degeneration, and the sweat-glands were enclosed in a dense cellular mass,
and their ej)ithelium was partially destroyed. After a moderate irradiation
with the X-rays other changes were noted, such as inflammation, oedema of
the epidermis, an infiltration of the corium with polynuclear leucocytes,
and a partial disappearance of the " mycosis cells " and the hyaline-degenerated
collagen. After a more prolonged irradiation the epidermis and corium ^n-e-
sented regenerative changes, and a large number of newly-formed blood-vessels
were noted. The cellular infiltration had largely disappeared, the hyaline-
degenerated collagen could no longer be seen, and the sweat-glands seemed
to have recovered their normal structure. In other words, there was a com-
plete disappearance of the pathologically-altered elements.

Exposm-e to the X-rays for fifteen minutes at a distance of 20-25 cm. with
a hard tube were employed. By this means not only did the tumoiu-s rapidly
disperse under the influence of the rays, but the itching, which is so distress-
ing a symptom, especially of the early stage of Mycosis fungoides, also
disappeared. J- M. H. M.

ON LUPUS ERYTHEMATODES IN CHILDHOOD. Galewsky.
{Archivf. Derm. «. Syj^h., Ai^ril. 1907 ; Neisser's Festscliriff, p. 193.)

The author of this contribution has luider his care at the polyclinic for chil-
dren at Dresden a case of Lupus erythematosus in a girl, aged Hi years, which
began when she was about five years old. The parents of the child were healthy
and she had four sisters alive. There w^is no history of tuberculosis in the
family. When the child was aged two years she sufl:"ered from eczema of the face
and back. When she was five years old the eczema became more marked, and
red spots developed on her nose and ears. These lesions were slightly raised,
and gi-adually assumed the typical characters of Lupus erythematosus, some of
them disappearing and being succeeded by white atrophic scars. In looking
over the literature the author foiuid seventeen cases which had begun between
the ages of two and ten years, and twenty-four between ten and sixteen years.

CUKMJlilNT LITKRATUK'K. 27

Of the seventeen cases above mentioned ten occurred in j^irLs. and out of the
twenty-four cases tifteen were girls. In only a few (jf these cases was there any
personal or family history of tuberculosis, while in the majority of cases all
evidence of tuberculosis was absent. J. M. H. M.

THE HISTOLOGICAL CHANGES IN LUPUS VULGARIS UNDER
FINSEN-LIGHT TREATMENT. H. Jansen and E. Delbanco.

(Archiv /. Dcnn. it. Sijph.. March. l!Hl7. p. ;52o.)

From a study of the histological changes produced in Lupus vulgaris when
exposed to Finsen light the writers of tliis paper have arrived at the following
conclusions. According to theii* observations the first changes which occur in
the tissue from the action of the light are dilatation of the blood-vessels and
oedema. Then follow cellular necrosis and the formation of a scab, and subse-
quently a localised inflammatory process witli migration of leucocytes. These
are followed hj a gradual process of regeneration and repair. The dilated blood-
vessels in the superficial layer of the corium are distended with blood, and some
are thrombosed. The endotlielial cells of the Avails of the vessels have desqua-
mated or have undergone fatty degeneration. Later, when the process of heal-
ing sets in a marked proliferation of the endothelium occurs. The muscle-fibres
are involved in the oedematous process and present a vacuolated appearance.
The plasma-cells and giant-cells of the tuberciilar infiltration are also oedematous
and show vacuoles, and the overlying epithelial cells present the changes graphi-
cally described by Unna as " spongy metamorphosis." The intercellular spaces
are also widened so that the whole tissue presents this spongy appearance. The
collagenous bundles are swollen and the individual fibres are here and there
separated by oedema. A few days after the exposure to the I'ays the nuclei of
the epidermal cells do not stain well and some of the cells are killed. The
destruction also involves the cells of the hair-follicle and the sweat-duct which
have come under the direct action of the rays. A cell destruction has also
taken place in the upper portion of the lupus infiltration. The cellular necrosis
sets up an inflammatory process, whereby a migration of leucocytes takes place,
and this in turn leads to the process of regeneration. The effect of the treat-
ment is tluis to cause a destruction of the pathological elements, and a gradual
process of repair which replaces the tubei-cular infiltration with healthy tissue.
The light also destroys the bacilli in the superficial layers by its direct action,
while those lying more deej)ly are indirectly killed by the inflammatory reaction.
The paper is illustrated by a series of drawings of sections of lupus at various
intervals after exposure to the light, and a liibliography of the literature on the
subject is appended. J- M. H. M.

MULTIPLE TELANGIECTASES OP THE SKIN AND MUCOUS
MEMBRANES OF THE NOSE AND MOUTH. A. Brown Kelly,
M.D. (Glasyon: Medical Journal, vol. Ixv, January to June, 1906.)

The wi-iter, in describing two cases of this rare alfection which had come
under his observation, mentions that he has found recorded j)reviously only eight

28 CURRENT LITERATURE.

cases of the disease. Tlie first case, a married women, aged 41 years, was seen
in May. 1898. on account of epistaxis. Her father had similar s^Dots to those
from which the patient suffered, on his face. He was subject to attacks of epi-
staxis and vomiting, and died, aged sixty-two, in consequence of frequent bleed-
ings from the nose. He had four brothers and one sister, all of whom were free
from the disease. The patient's mother did not suffer fi-om the affection. The
patient had fom* brothers and three sisters ; all of them were unaffected with
the exception of one sister, the second case described by Dr. Kelly.

The patient had three children : a boy died of diphtheria ; a daughter, twenty-
three years of age, has recently develoi^ed telangiectasis and has long had slight
attacks of epistaxis ; a son, aged twenty, has not suffered from epistaxis nor
telangiectasis. The patient has suffered from epistaxis from girlhood. At the
age of twelve the attacks were severe ; they became less severe when menstrua-
tion was establislied at the age of eighteen, and continued to improve after her
marriage at twenty-four until her husband's death five years later. Afterwards
the epistaxis became more frequent, and red spots appeared on the face. During
the last ten years of her life the spots gradually increased in number and size,
while the epistaxis on a few occasions reduced her to extreme prostration.

In 1898 the spots on the face were like pin pricks, situated a little distance
beneath the surface of the skin. They were largest and most closely grouped
over the cheek bones and lobes of the ear. They were also seen on the palmar
surfaces of the finger tips. The mucous membrane of the nasal fossae were found
to present a great number of telangiectases as bright dots, short lines, or spider-
like formations. On an average they were about 4 mm. apart, and not more
than 2 mm. in length. Some projected markedly beyond the surface, so that a
slight cause injured the delicate covering and led to epistaxis. In the mouth
there were three or four similar small spots about the middle of the tongue.

In 1900 the telangiectases on the cheeks had greatly increased in number and
were seen on neighbouring parts. In 1905 the scattered red spots had been
replaced on the cheeks by tortuous dilated vessels, surrounded hj discrete
telangiectases. The tortuous vessels and larger spots were purplish and con-
siderably elevated. The auricles, finger-tips, and palms were siuiilai4y affected,
and two spots were noticed on the right breast. On the nasal miicous memljrane
the vessels were larger and more prominent, and the telangiectases were more
numerous. She died suddenly in the summer of 1905 (July) from syncope,
induced by very severe and j)ersistent epistaxis.

The second case is the younger sister of the patient already mentioned. She
began to suffer from troublesome Ijleeding from the lips and tongue at the age
of seventeen. Red spots first appeared on the skin close to the lower lip in her
twenty-seventh year, and on the cheeks and fingers when aljout thirty-five. A few
have develoi^ed on the scalp, and in all these situations the spots are increasing
in number and size. The condition of the patient was not aft'ected either by the
commencement of menstruation or subsequently. » While pregnant she had very
severe bleedings. Bleedings from the tongue and lips, less often from the nose,
and only in consequence of injury to the skin, frequently occurred. Severe
hajmon-hages are followed by eruption which tlie patient describes as like nettle-
rash. Tliis j-ash passes from one region to another, and is never entirely absent
if epistaxis has taken place at short intervals. There seems to be no definite

CrRRENT LITERATUllK. 29

lisemophilia. l>ut wounds lioal slowly ; l>ruising is readily caused and lasts long,
and swellini; of the lower eyelids is occasionally present in the morninj^ after a
severe luvniorrhage. l.)ut passes off durint^ the day. The small telangiectases
caiise no disoonif(.)rt, except those beneath the finger-nails, which are occasionally
painful. The larger ones vary in size from time to time ; when she is " full-
blooded," as she says, they are more prominent, and are flatter and paler after a
hjEmori-hage. There are spots on her tongue and her hard palate, and telangiec-
tases occur also on the anterior ends of the inferior turbinate bones.

References. — William Osler.— '• Ona Family Form of Recurring Epistaxis
Associated with Multiple Telangiectasis of the Skin and Mucous Membranes,"
Johns Hojikins Hosj). Bull., November, 1901, p. 333. Rendu. — " Epistaxis
repetees chez un sujet poi-teur de petits angiomes cutanes et muqueux," Gaz.
des Hopitaux, 1896, No. 135, p. 1322. C. O. Hawthorne— '• Recurring
Epistaxis with Multiple Telangiectases of the Skin," Lancet, 1906, vol. i, p. 90.
WiCKHAM Legg.— " A Case of Haemophilia Complicated with Multiple Njevi,"
Lancet, 1876, vol. ii, p. 856. O. Chiari. — Erfahnnujen avf dem Gehiete der Hals-
und Nasenkrankheiten. S. 60, et seq., Wien, 1887.

In the Quarterly Journal of Medicine, vol. i, October, 1907, Professor Osier
gives an account of this condition nnder the title, "On Multiple Hereditary
Telangiectasis with Recun-ing HEemon-hages," reproducing the jjlates published
by Dr. Kelly in the Glasgoiv Medical Journal, and in addition a plate showing
the condition of the face in a patient coming under his own observation. This
patient was seen by Dr. Osier in consultation in New York, and an account of
his case is given in the Journal of the American 3Iedical Association, October
6th, 1906. The patient apparently belonged to a " bleeder" family. His grand-
father and one sister had the spots and bled in the same way. His son, a young
man of twenty, had occasional epistaxis. but no spots. The patient himself had
numerous telangiectases of the skin of the face, ears, and lips. He had frequently
suffered severely from haemorrhage, chiefly from the nose, but also from spots.
A year later this patient had improved much in health, he had gained weight
and strength, and felt better than he had done for years. During this period of
convalescence he had taken calcium lactate, 20 grs. three times a day, and some
prominent spots on the face had been touched with the electric needle.

Dr. Osier gives an account of the families already recorded ; there seem to be
at the present time at least eight families on record showing this remarkable
condition. In addition to the references already given. Dr. Osier refers to
Parkes Weber's case, shown at the first meeting of the Association of Physicians
in May {Lancet, 1907, vol. ii), to Dr. William Bligh's case {Lancet, 1907, vol. ii),
and we understand that at least one other case has been recently observed in
London.

J. G.

30 EEVIEWS.

REVIEWS.

Light and X-Ray Treatment of Skin-Diseases.*

This is a volume in Cassell's " Modern Methods of Treatment " series, giving
the experience of Mr. Morris and Dr. Dore in the treatment of skin-diseases by
light and X-rays. The snliject matter of the book is arranged in a number of
chaj)ters dealing, first with the principles of the practical application of rays of
light by the method originated by Finsen, of the X-rays, of radium and high-
frequency currents. The latter part of the book deals with the clinical results of
treatment in various diseases, especially Lupus vulgaris, rodent iilcer, and ring-
worm, observed in the authors' practice. A noteworthy feature of the liook is
the clear and unmistakable description, both of methods of treatment and the
results obtained. It is true that the beginner may find some difficulty in follow-
ing the explanations given of the apparatus, a natural result of the comparatively
small space at the authors' disposal. This, however, cannot be regarded wholly
as a disadvantage. The unhappy and only too freqvient accidents and examples
of damage done by the inexperienced and too enthusiastic experimenter with
these forms of treatment are becoming well kno\\ni to those who have to see the
results.

The characteristic note of the book is that of caution and full consideration of
all cases subjected to treatment l^y these methods. To some a feeling of disap-
pointment will be conveyed on account of the guarded way in which the authors
express the conclusions which they have formed as the result of their large
experience ; but the volume is to be welcomed as giving a sane and well-con-
sidered statement of the numerous disadvantages, as well as the obvious gain to
treatment, especially by means of " Finsen " light and the X-rays. It must be
felt by those having considerable exi^erience in dermatology that one of the
I'esults of the few years' trial of these newer methods of treatment will be a
revival of older methods improved in their application by the knowledge of such
facts as the need for continuity in treatment acqiiired l)y the methods of irradia-
tion. To all those who entertain the idea of applying treatment by means of
light and X-rays, and even to those with some experience, the pages of the
introduction, and the conclusions of the vax'ious chapters on the different
varieties of treatment, are to l)e commended for perusal. The result can hardly
fail to be a diminution in the number of unfortunate experiences and disfiguring
results and an increase in the number of successful cases.

J. G.

LeHRBUCH DER HaUT-UND GESCHLECTSKRANKHEITEN.f

Professor Finger has written an excellent text-book on diseases of the skin,
to be followed during the course of this year Ijy a second volume on venereal

* Light and X-Ray Treatment of Shin-Diiicases. By Malcolm Morris,
F.R.C.S.Ed., and S. Ernest Dore, M.D., M.R.C.P. With 12 plates. Pp. 172.
Cassell & Co., Ltd.

t Lehrbucli der Haut-und GescJilectukrankltciten. First part. By Professor
Ernest Finger. Leipzig and Vienna : Franz Deuticke, 1907. Pp. 396. Price
10 marks.

i;i:\ii;\vs. 31

diseases. This first volume comprises a detailed description of the various forms
of skin-diseases, es^jecial attention ]jein<^ jjaid to therapeutics and treatment.
Patholoi^ical anatomy is not perhaps dealt with as fully as in some other text-
books, and there are only five coloured plates sliowin<^ the histological appear-
ances of a few common skin-affections. The liook is, however, essentially
practical, and can be recommended most strongly both to the student and
pi-actitioner. The various methods of treatment are fully discussed and the most
appropriate remedies described imder the heading of each disease. Occasionally
methods of treatment other than the application of medicaments are merely
mentioned ; thus, imder the treatment of ringworm it is stated that definite and
rapid results are often olitained ])y Rontgen rays, but no description is given of
the necessary technique. As showing the rarity of the microsporon variety of
ringworm 'ji Vienna, Finger says it only occui-s in small epidemics, of which he
has seen one in a Vienna orphanage. The large spored variety is more common,
but still comparatively rare as contrasted with other counti-ies. His statement
that tinea due to the microsporon occurs only in children under fifteen years of
age, and undergoes spontaneous cure about this time needs, perhaps, some qualifi-
cation when judged by the expei'ience of dermatologists in London.

The author's views on the subject of Pityriasis rubra pilaris are of interest.
He states that it was, and is, attempted to differentiate this disease from Lichen
ri;ber acuminatus and regard it as a disease sui (jeneris. Differentiating factors
were held to exist in that in Lichen ruber acuminatus the infiltration is primary,
hyjjerkeratosis secondary, while in Pityriasis rubra pilaris the disease begins
with hyperkeratosis of the hair-follicles and the infiltration phenomena are
secondary. Stress was laid on the point that Lichen ruber acuminatus when
general is a fatal disease, while a favourable prognosis can be given in Pityi-iasis
rubra pilaris. But, says Finger, neither clinical nor histological examination
proves the absolute validity of these differences, and it appears to him to-day more
than probable that the two names have been api^lied to the same disease. Con-
sequently, he himself gives a description of Pityriasis iiibra pilaris under the
heading of Lichen ruber. As treatment for Lichen ruber he relies on arsenic
as a specific, increasing the dose gradually to the highest which can be well
tolerated, continuing this large dose until the lesions entirely disappear, and
then gradually lowering it.

In conclusion, the work forms an admirable text-book, which will be read with
interest by all and will be of the greatest assistance to the practitioner.

J. L. B.

Transactions of the German Dermatological Society. Ninth

Congress.*

The second volume of the repoi-t of this most interesting Congress has now
appeared, and contains an account of numerous cases brought before the
Congress and a summary of a few discussions. We regret, however, to find that
only one London dermatologist was a member of the Congress, but the fact of

* Verhandlungen der Deutscheu Dermalologischeu Gesellscliaft. Ninth Congress,
held at Benie, September 12th-l-ith, 1906. Second Volume. Berlin : Julius
Springer, 19u7. Pp. 546.

32 REVIEWS.

the Congi'ess being held so far away as Berne is no doubt accountable for this.
Among many other instructive cases was one of Jadassohn's of a case of pseudo-
leuksemic (?) disease of the skin. The jjatient was a woman, aged 29 years, with
niimerous lesions on both cheeks varying in size from the infinitesimal to almost
that of a cherry. The consistence of the lesions made the diagnosis of Lupus
tumidus possible, and this was only disproved by the results of tuberculin injec-
tions and histological examinations. The benignant "sarcoids" or "lupoids"
of Boeck were also out of court, and the histological picture spoke, in the first
place, for lymphoma. But of simple lymphomata we know nothing, and the
question arises whether a leuksemia or pseudo-leukaemia can show itself only by
an affection of the skin. This case was at any rate cured by arsenic, and now, at
the age of thirty -three, is in an excellent state of health. Numerous other cases
were shown l)y Jadassohn, Lewandowsky, Cohn, Heuss, Fabry and others.
An interesting demonstration of varioiis forms of spirochtste was given by Rona
from the point of view of the difference between Schaudinn's spirochsete and those
occurring in, or causing, necrotic processes. Such differences he was able to
demonstrate in sections as plainly as in the usual cover-slip preparations,
where the differences are well shown. He mentioned that forms of spirochsete
are known in necrotic processes, such as noma, stomatitis. Ulcus gangrsenosum.
Balanitis ulcerosa, Vincent's angina, pidmonary and nosocomial gangrene, and
that in many of these affections the spirochsete appears to be morphologically
identical. Some of the discussions were very interesting, and the report, as a
whole, foi-ms most attractive reading, on which Professor Jadassohn is to be
heartily congratulated.

J. L. B.

Archiv fur Dermatologie und Syphilis.

The eighty-fourth and eighty- fifth volumes of the Archiv f. Derm. u. Syph.,
issued in April and May, 1907, are dedicated to Professor Neisser, of Breslau, to
celebrate his twenty-fifth year as Professor and Director of tbe Dermatological
Clinic at Breslau. These volumes, of upwards of 400 pages each, consist of con-
tributions by a large number of Neisser's pupils, among whom are such well-
known wi-iters on dermatology as Herxheimer, Jacobi, Juliusberg, von
Marschalko, Philippson, Walther Pick, Pinkus, von Winiwarter, and others.
Abstracts of the various papers will be published in the journal. With our
German colleagues we heartily join in ovir appreciation of the great work
Professor Neisser has done and the influence he has exerted in the advancement
of dermatology during the last quarter of a century, and in hoping that for
many years he may be spared to preside over the justly renowed Breslau School.

J. M. H. M.

THE PHYSICIAN OF MANY YEARS' EXPERIENCE

Knows that, to obtain immediate results in tlie treatment of

AnaBtnia, Neurasthenia, Pulmonary TubercuEosSs,

ans§ wasting diseases of ciiildhoosl, and also
during convalescence front exhausting diseases,

THERE IS NO REIVIEDY
LIKE FELLOWS^ SYRUP.

Many medical journals and text-books specifically mention it
as being of sterling worth.

TRY IT, AND PROVE THESE FACTS.

SPECIAL NOTE.— Fellows' Syrup is never sold in bulk. It can be obtained of
chemists and pharmacists everywhere.

Stilphaqua

For the production of NASCENT SULPHUR in the ordinary BATH in the
treatment of ECZEMA, PSORIASIS, SCABIES, GOUT, RHEUMATISM,
etc. Assists as a disinfectant during- the peeling after SCARLET FEVER, and in
allaying the irritation, and will be found most useful in all cases where SULPHUR

BATHS are required.

Bath Charges in boxes of 1 dozen; Toilet Charges in boxes of 2 dozen.

Physicians arc requested to ivrite for Samples and Literature.

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NOW READY,

A SPECIALLY ILLUSTRATED EDITION,

WITH

72 ADDITIONAL FULL=PAGE PLATES, from PHOTOGRAPHS.

THIRD EDITION; 76 Plates (2 Coloured) and 112 Illustrations.
Two Vols., Large 8vo, 30s. net.

Diseases of the Skin :

THEIR DESCRIPTION, PATHOLOGY, DIAGNOSIS,
AND TREATMENT,

with Special reference to the Skin Eruptions of Children, and an Analysis of 15,000

cases of Skin Disease.

By Hm Rattciiffe' Crocker,

M.D.Lond., F.R.C.P.,
Physician for Diseases of the Skin, University College Hospital, London.

"It is always a pleasure to read a work written by one who is a master of his subject, and the
perusal of this edition of this worlc would convince any member of the medical profession that it was
indeed the production of an authority on dermatology. We extend a cordial welcome to the third
edition." — TAe Lancet.

" The author's grasp of his subject, and liis clear and vigorous exposition, are fully apparent in the
present edition. The practical character of the book, both to the student and practitioner, and its value
as a work of reference are fully maintained." — British Medical Journal.

London: H. K. LEWIS, 136, Gower Street, W.C.

With 40 Plates (Eight being in Colours) comprising lOO Figures. Demy 8vo, 15s. net.

PRACTICAL HANDBOOK OF

The Pathology of the Skin.

An Introduction to the HISTOLOGY, PATHOLOGY,
and BACTERIOLOGY OF THE SKIN, with SPECIAL
REFERENCE TO TECHNIQUE.

By Jm M. H. Macleod,

M.A., M.D., M.R.C.P.,

Assistant Physician for Diseases of the Skin, Charing Cross Hospital ; Physician to the

Skin Department, Victoria Hospital for Children;

Lecturer on Skin Diseases, London School of Tropical Medicine.

"We know no other work in any language written on the same lines. We congratulate Dr.
Macleod on his book, for it is a credit to British Dermatology."— 7"/;^ Lancet.

" Dealing as it does with methods of research, and the results of these methods, it sets out in an
admirably clear way the morbid changes which the dirterent layers of the skin undergo, giving as ex-
amples the various diseases in which these changes are to be met with. They are made intelligible,
even to those who are not already acquainted with this branch of pathology, by means of a very large
number of beautiful illustrations, upon which both the author— who is his own artist— and the publisher
are to be highly congratulated." — Practitioner.

London: H. K. LEWIS, 136, Gower Street, W.C.

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and is extremely efficacious in Eczema and Acne.

EMOL-KELEET is a purified, natural product, somewhat allied to superior
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THIOL

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An artificially prepared substance consisting of Sulplionised Hydrocarbons.

ANTISEPTIC AND MILDLY ASTRINGENT IN ACTION.

AGREEABLE IN ODOUR AND TASTE.

THIOL LlQUiDUM. THIOL 51CCUM.

Thiol Liquidum is more convenient for general use in salves and
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Thiol has proved exceedingly useful in Skin Diseases and in Gynae-
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51 Thiol Liquid. ... 5iv. 51 Thiol Sice. Pulv. 5j.

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To be used with a camel-hair To be applied with a camel-hair

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51 Thiol Liquid. ... 5j. I^ Thiol Liquid. ... 5j.

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Lanolin ... ... 5vj. ut ft. pil. xl.

To be used as an ointment. Sig. Two three times a day.

THIOL LIQUIDUM in ERYSIPELAS.

A medical man writes: "I have found it a specific for Erysipelas. It
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at once."

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Contains 10 % Thiol and 20 % Zinc Oxide.

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THIOL SOAP C'Bovar' Brand). 6d. per Tablet.

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JAMES WOOLLEY, SONS & CO., LTD., MANCHESTER.

Entered at the New York Post OUice as Second Class f-Jatter.

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